DD1423_Redacted.pdf

Template last updated 10/21/2021

CONTRACT DATA REQUIREMENTS LIST

(1 Data Item)

Form Approved

OMB No. 0704-0188

The public reporting burden for this collection of information is estimated to average 110 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden, to the Department of Defense, Executive Services and Communications Directorate (0704-1088). Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number.

Please do not return your form to the above organization. Send completed form to the Government Issuing Contracting Officer for the Contract/PR No. Listed in Block E.

A. CONTRACT LINE ITEM NO.

B. EXHIBIT

A

C. CATEGORY:

TDP_____ TM ______ OTHER: MGMT

D. SYSTEM/ITEM

MAINTENANCE SERVICES

E. CONTRACT/PR NO.

12254892

F. CONTRACTOR

RPM INNOVATIONS INC

1. DATA ITEM NO.

A001

2. TITLE OF DATA ITEM

MAINTENANCE SERVICE REPORT

3. SUBTITLE

MAINTENANCE RECORD DOCUMENTATION

4. AUTHORITY (Data Acquisition Document No.)

5. CONTRACT REFERENCE

PWS C.4.3

6. REQUIRING OFFICE

FCDD-RLA-MD

7. DD 250 REQ

LA

9. DIST STATEMENT

REQUIRED

A

10. FREQUENCY

AS NEEDED

12. DATE OF FIRST

SUBMISSION

NLT 7 DAYS AFTER EACH

SERVICE VISiT

14. DISTRIBUTION

a. ADDRESSEE

b. COPIES

8. APP CODE

N/A

11. AS OF DATE

N/A

13. DATE OF SUBSEQUENT

SUBMISSION SEE BLOCK 16

Draft Final

Reg Repro

16. REMARKS

BLK 4: CONTRACTOR FORMAT IS ACCEPTABLE. EACH REPORT SHALL BE DELIVERED

ELECTRONICALLY VIA EMAIL AT TIME OF DELIVERY TO:

[REDACTED]

BLK 10, 12 & 13: REPORTS REQUIRED AS GENERATED. DATE OF FIRST SUBMISSION

SHALL BE NLT 7 DAYS AFTER EACH SERVICE VISIT IS COMPLETED.

BLOCK 13: SUBSEQUENT SUBMISSIONS WILL BE 7 DAYS AFTER SITE VISIT.

TBD 1

15. TOTAL

G. PREPARED BY

TBD

H. DATE

APRIL, 9, 2025

I. APPROVED BY

Shanna Dellinger

J. DATE

April 10, 2025

DD FORM 1423-1, FEB 2001 PREVIOUS EDITION MAY BE USED. Page of Pages

X Contract Specialist

X Contracting Officer (KO)

EXHIBIT A – ATTACHMENT 1

ARMY RESEARCH LABORATORY

Report Title Goes Here Any Subtitles Go Here

By Some Author and Another Author

Month XXXX

Prepared by

Whatever Technology Corporation 0000 Research Drive

Anywhere, ST 20006-1000

Under contract

W911QX-XX-C-XXXX

DISTRIBUTION STATEMENT GOES HERE

EXHIBIT A – ATTACHMENT 2

The findings in this report are not to be construed as an official Department of the Army position unless so designated by other authorized documents.

Citation of manufacturer's or trade names does not constitute an official endorsement or approval of the use thereof.

DESTRUCTION NOTICE: For classified documents, follow the procedures in DoD 5220.22-M, National Industrial Security Program Operating Manual, Chapter 5, Section 7. For unclassified, limited documents, destroy by any method that will prevent disclosure of contents or reconstruction of the document.